Self-Study Modules for Effective TB Interviewing
Challenges During the TB interview
If the medical record review does not suggest the existence of
any special circumstances, or if no medical record is accessible,
it is the interviewer’s responsibility to interpret verbal and nonverbal
cues that may influence the successful exchange of information.
The following circumstances may cause challenges to conducting a
- Unlikelihood of Follow-up Interviews
Some patients may be difficult to locate for more than one interview,
making the initial interview most important for collecting information.
To the extent possible, all objectives of the TB interview must
be accomplished during this one interaction. For example, patients
who are homeless or have a history of migration can be difficult
to locate for follow-up interviews.
- Distrust of Authority
Past negative experiences with government or healthcare agencies
may cause a patient to refuse interview requests or to provide
little or no information during the TB interview.
- Fear of Legal Consequences or Moral Judgments
Anything alluding to the legality or morality of patient actions
can frighten a patient who is involved in illicit or illegal activities
such as drug use, undocumented immigration status, commercial
sex work, or previous negative experiences with the law.
A patient can be reluctant to reveal participation in behaviors
that are illegal, perceived as immoral, or different from that
of mainstream society (e.g., drug use, unreported work, or alternative
lifestyle). The patient can also fear the consequences of revealing
that contacts are involved in illicit activities. This fear can
outweigh the perceived responsibility to identify priority contacts
exposed while engaging in these activities.
- Inability to Provide Identifying and Locating Information
An index patient may make sincere attempts to identify priority
contacts. However, due to the nature of the patient’s or contacts’
lifestyles (e.g., homelessness or substance abuse) or the setting(s)
(e.g., drug den, bar, or social club) in which the contacts were
exposed, the patient may not be able to provide the names or locating
information of the contacts.
- Undocumented Immigration Status of Contacts
If contacts are in the country illegally or were exposed in a
work setting and do not have valid work permits, a patient may
hesitate to name them for fear of jeopardizing their status in
the country and at the work site.
- Unmet Personal Needs and Coexisting Medical Conditions
A patient may consider health, housing, family, occupational,
or financial concerns as being of higher priority than completing
TB treatment or participating in the contact investigation process.
Persons who are homeless, HIV infected, primary caregivers, or
on public assistance may not be entirely engaged in the interview
process due to other concerns.
- Physical or Mentally Inability to Adequately Communicate
Some patients may not be competent or able to understand or communicate
effectively because of a physical or mental disability.
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333